Tartar Qurani Alifitriah, Park Kyung Nam, Seo Kwang-Suk, Karm Myong-Hwan
Department of Dental Anesthesiology, School of Dentistry and Dental Research Institute, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Sci Rep. 2025 Jan 4;15(1):809. doi: 10.1038/s41598-024-83843-0.
Oropharyngeal and orthognathic surgeries cause more postoperative pain than simple dental procedures. The lack of detailed pain pattern analysis after dental surgeries makes pain management challenging. We assessed postoperative pain patterns in patients undergoing various dental surgeries, categorized based on changing pain levels, and identified the most frequent surgical procedures within each pain pattern cluster. Patients aged 18 years and older undergoing elective oral and maxillofacial surgeries under general anesthesia and hospitalized for > 36 h were included. Exclusion criteria were COPD, head injury, adverse drug reactions, substance misuse, severe metabolic disorders, infections, or psychiatric conditions. We retrospectively analyzed previously collected postoperative visual analog scale (VAS) data at 0, 6, 12, 24, and 36 h postoperatively from 790 patients undergoing various dental surgeries under general anesthesia using k-means clustering to identify pain patterns. Surgery type, duration, and patient-controlled analgesia were analyzed for three pain clusters. Cluster 1 had high prolonged initial pain (VAS 7.43 ± 1.62), mostly involving extensive oropharyngeal cancer surgeries. Cluster 2 experienced moderate pain initially (VAS 5.95 ± 1.44), steadily declining, typically involving orthognathic surgeries. Cluster 3 reported moderate initial pain (VAS 5.21 ± 1.49) that decreased rapidly. Extensive procedures were common in Cluster 1, whereas simpler excisions were prevalent in Cluster 3. Postoperative pain varies significantly according to the extent and invasiveness of surgery. Identifying specific pain trajectories based on detailed surgical assessments can enhance preemptive pain management and aid clinicians in predicting and managing postoperative pain.
口咽和正颌手术比简单的牙科手术会导致更多的术后疼痛。牙科手术后缺乏详细的疼痛模式分析使得疼痛管理具有挑战性。我们评估了接受各种牙科手术患者的术后疼痛模式，根据疼痛水平变化进行分类，并确定了每个疼痛模式集群中最常见的外科手术。纳入年龄在18岁及以上、在全身麻醉下接受择期口腔颌面外科手术且住院时间超过36小时的患者。排除标准为慢性阻塞性肺疾病、头部损伤、药物不良反应、药物滥用、严重代谢紊乱、感染或精神疾病。我们回顾性分析了之前收集的790例在全身麻醉下接受各种牙科手术患者术后0、6、12、24和36小时的视觉模拟量表（VAS）数据，使用k均值聚类来识别疼痛模式。对三个疼痛集群的手术类型、持续时间和患者自控镇痛进行了分析。集群1有高且持续时间长的初始疼痛（VAS 7.43±1.62），主要涉及广泛的口咽癌手术。集群2最初经历中度疼痛（VAS 5.95±1.44），并稳步下降，通常涉及正颌手术。集群3报告初始疼痛中度（VAS 5.21±1.49）且迅速减轻。广泛的手术在集群1中常见，而较简单的切除术在集群3中普遍。术后疼痛根据手术的范围和侵入性有显著差异。基于详细的手术评估识别特定的疼痛轨迹可以加强预防性疼痛管理，并帮助临床医生预测和管理术后疼痛。
